Mental ill-health accounts for around 20% of the disability burden, but mental health services typically attract only around 4% of national health budgets. Similarly, only 5% of the overall EU health research budget is spent on mental health.
Parity of esteem is needed; and funding that matches the extent of the problem. In talking to policy makers and other stakeholders, patients and psychiatrists need to speak with one strong and united voice, Professor Galderisi, past president of EPA, University of Campania Luigi Vanvitelli, Naples, Italy, argued.
Patients and psychiatrists need to speak with one strong and united voice
Besides, if we empower patients we empower ourselves; and empowered patients are also a valuable resource.
Philip Gorwood, president of EPA, endorsed that view and reflected on the factors needed to underpin a good relationship. Matching what the patient expects with adequate expertise, and at the right time and in the right place, is the foundation of a good relationship, he suggested.
The first encounter is the one that has to build the therapeutic alliance. That cannot be rushed. But these days it all too often is, because of the pressure to see so many patients.
Though their aims may be the same, patients and psychiatrists undoubtedly have different perspectives.
Bringing out what is best in their relationship, while better understanding aspects that are found difficult, is the aim of a groundbreaking research collaboration that will bring together the narratives of twenty pairs of patients and psychiatrists drawn from Finland, France, Italy, Romania and the Netherlands. The project focuses on people with experience of being treated for depression, including bipolar disorder.
Matt Muijen, Brussels, Belgium, who is on the GAMIAN Board, described the joint initiative to establish what works and does not work in real patient/psychiatrist relationships. The project will conduct in-depth qualitative analysis of their experiences, followed by focus groups to explore issues such as:
- Interventions that might encourage trust and a positive relationship
- The adequacy of tools and resources to provide good quality care
- Support for the morale of healthcare professionals, and
- Aspects of education and training that might prepare healthcare professionals better
The therapeutic relationship is crucial, especially for conditions needing long-term care
Anouk Drieskens (Geel, Belgium) who is both a clinical psychologist and someone who is an “expert by experience”, spoke of her life since being diagnosed (somewhat belatedly) with bipolar disorder type 2.
For her, optimal care – while acknowledging the patient’s vulnerability -- is based on a belief in and vision of recovery. It is holistic, encourages joint efforts focused on finding solutions, and includes:
- The joint drafting of care plans and shared decision making that takes into account the individual’s values, thoughts, feelings, skills and roles
- Encouragement of self management
- The involvement of close relatives
- Use of tools to give advanced warning of impending crises – and to prevent them where possible
- Encouraging to the maximum participation in society, and
- Effective co-operation between healthcare professionals
Optimal care involves a joint effort focused on finding solutions and belief in recovery
GAMIAN, which has a membership spanning 26 European countries, represents the views of people with mental disorders and gives them a voice in the development of sound EU and national policies on service provision, Hikka Karkkainen, Finland, president of GAMIAN-E, told at the joint workshop. As a sign of close co-operation with others, notably the EPA, the president of GAMIAN is a voting member on the Association’s Board.
Among current GAMIAN initiatives is the development of a charter for people with schizophrenia which will cover topics, such as advocacy and the right of access to a safe place at times of crisis. In May 2018, it launched a Call to Action to highlight the need to improve patient empowerment and self-management in mental healthcare.
Past publications include Breaking the Silence: Sexual health impact on mental wellbeing and A Sustainable Approach to Depression.
A new lexicon?
Closing the workshop, Silvana Galderisi raised the question of vocabulary: should we be talking of patients, or clients, or service users? Should we use the term mental disorder? Should there be an agreed lexicon, or is diversity fine? Issues for a different time – but another example of the need for a collaborative approach.